A sign seen, at the entrance to St Thomas' Hospital, part of the National Health Service, in London, 14 Aug 2009As the United States debates health-care reform, VOA is looking athealth-care services around the world.

The idea behind Britain'shealth-care system is straightforward, says Michael Summers of thenon-profit Patients Association that helps people understand theNational Health Service.

"Everyone is entitled to free healthcare at the time of need, both in relation to consulting their generalpractitioner, and to hospital treatment and operations. It is free,"he said.

Summers explains every worker in the country pays for it through a national insurance tax.  

"Itis relatively cheap for what you get, and it has been in existence for60 years, so it is well established as a health service and it works,"he said. "It is not perfect, but then there is no country that has aperfect system."

Everyone is covered

One of its strengths is everyone is covered, says Fiona Wise, who runs three London-area hospitals.

"Weprovide care for elderly people, for mothers to be, for newborn babies,for children, and we provide long-term care for certain groups ofpatients who have what we would describe as chronic illnesses," saidWise.

Summers says the service takes care of people, not just in hospitals, but in doctors offices and dentists throughout Britain.

"Itis vast, absolutely vast," he said. "It is the biggest employer in thecountry. It is said to employ more people than the Red Army, if thatis a comparison. It is vast, it costs an enormous amount of money, butof course it is funded from taxation and the contribution made bypatients."

Drawbacks

The sheer size of the service is at the heart of manycomplaints, such as long waiting times, canceled operations and poornursing care.  

Errors by doctors who are either too pressed fortime or inadequately funded are also a growing problem. Studiesindicate up to 15 percent of all patients in Britain are diagnosedincorrectly or have ailments that are overlooked.

Cancerspecialist Dr. Karol Sikora says the quality of care is uneven, becauselocal authorities decide which medications or treatments are available.

"Eachof them has a different philosophy about heart disease, about cancer,about mental illness," said Sikora. "And the services you get, forwhatever it is you need, depends critically on where you live. We callthis post-code prescribing."

Some patients have waged campaignsin the courts or the media in order to get access to treatment ormedicine authorities have deemed too expensive, even if it prolongslife.  

Sikora says British authorities lag behind other European nations in making cancer drugs available.

"Ifthey take three years to decide whether a drug for kidney cancer can beincluded or not, then that is three years of kidney cancer patients whocannot get the drug and that is what we have seen during the pastseveral years," she said.

Advantages

But having a national health-careservice does have its advantages in some areas. The Britishgovernment's chief medical adviser, Liam Donaldson, says it makesorganizing vaccinations and planning a response to flu outbreakseasier.

"We can, if necessary, be very centralized," saidDonaldson. "We can get stockpiles of anti-virals, we can distributethem to people, we can put a vaccine program in place and get very highlevels of coverage. When we have shortages in one part of the country- of beds or intensive-care beds - we can ensure that a network ofservices provides them in another part of the country."

But thecritics and supporters agree one of the British national healthservice's biggest challenges, as it enters its seventh decade, are themounting cost of new technology and medicines, and an agingpopulation.